Rethinking digital mental health as a relational system: implications for interpretation, complexity, and care

Digital mental health technologies are increasingly positioned as scalable solutions to rising demand within overstretched health systems, offering accessible and continuous forms of support. However, their integration also raises important questions about how care is communicated, interpreted, and understood within digitally mediated environments.

This research draws on a multi-phase PhD study exploring digital communication in obesity and mental health care, with a particular focus on how standardised AI-generated scenarios are interpreted by health professionals (n=93) and members of the public (n=183). Using AI-generated video case studies to simulate patient communication, the study examined care prioritisation, lifestyle priorities, and perceptions of trust in relation to digitally mediated communication.

Findings indicate that while clinical narratives were held constant across scenarios, interpretation was not uniform. Public participants showed variation across avatar presentations in selected domains, including economic context, despite a shared core narrative, whereas health professionals’ rankings remained comparatively stable.

Across both cohorts, psychological and lifestyle-related support was prioritised over biomedical interventions, suggesting a shared biopsychosocial framing of care. Differences emerged in the emphasis placed on sociocultural context and lifestyle content, with health professionals prioritising cultural factors more highly, while public participants prioritised topics, such as gut health.

Perceptions of AI-generated communication were marked by ambivalence rather than rejection, with no significant differences observed between cohorts. Concerns centred on the loss of human touch, potential miscommunication, and the preservation of relational care.

Together, these findings point to a broader tension within digital mental health systems. While standardisation may support scalability and efficiency, it does not remove the interpretive and relational work involved in understanding complex, lived psychosocial experiences. Digital communication therefore does not simply transmit information but shapes how care needs are recognised and prioritised in practice.

This work suggests that digital mental health systems should be understood as adaptive sociotechnical systems, where outcomes emerge through interactions between users, technologies, and context. It highlights the need for design approaches that support context-sensitive and relationally grounded communication, ensuring digital innovation enhances rather than constrains meaningful care, particularly in the design and implementation of digital mental health services.